Purpose & Patient Population :

To update the 2005 Spanish Society of Medical Oncology (SEOM) clinical guidelines for the treatment of chemotherapy-induced emesis and to continue to improve the supportive care of patients with cancer

Type of Resource/Evidence-Based Process:

The Clinical Guideline Working Group, on behalf of the Spanish Society of Medical Oncology (SEOM) Executive Committee, provided expert opinion based on a review of the literature covering patients with cancer receiving chemotherapy.

Phase of Care and Clinical Applications:

All patients were in active treatment. This paper has application to antiemetic drugs.

Guidelines & Recommendations:

For highly emetogenic chemotherapy, one-day regimen, the following is recommended.

Palonosetron, a second-generation serotonin receptor antagonist, has been shown to be at least equally effective as first-generation antagonists when controlling acute emesis and more effective than first-generation antagonists when controlling delayed emesis.

Combining dexamethasone with other antiemetics is more effective at controlling chemotherapy-induced nausea and vomiting (CINV) than using dexamethasone alone.

For anticipatory nausea and emesis, use benzodiazepines, such as lorazepam.

The authors cautioned that the use of metoclopramide as an antiemetic is limited by the presence of serious side effects such as akathisia, extrapyramidal reactions, and dose dependency.

Nursing Implications:

Prevention of CINV can be accomplished through pharmacologic interventions, increasing patients' quality of life. The use of 5-HT3, along with dexamethasone and aprepitant, seems to be the most effective regimen. Although these recommendations are helpful, no insight into cost implications and little discussion of potential side effects of antiemetic treatment were provided. Additionally, the recommendations offered are purely pharmacologic and, thus, only aimed at those with prescriptive authority.